Updates in Diagnosing and Treating Peripheral T-Cell Lymphoma

Jia Ruan, MD, PhD, Weill Cornell Medicine, shares updates on the diagnosis and treatment of peripheral T-cell lymphoma at the 2019 Lymphoma Myeloma Congress.

Transcript:

Jia Ruan:  Hi. Good afternoon. My name is Jia Ruan. I'm a lymphoma physician at Weill Cornell New York-Presbyterian Hospital. My specialty is to take care of patients who have lymphoma, all different subtypes.

One of my research interests is to study patients with peripheral T-cell lymphoma. It is a very challenging subtype of non-Hodgkin lymphoma for a number of reasons. One is that it's quite heterogeneous. There are over 30 different subtypes.

We're actually coming to understand the biology pathogenesis which helps us to make a better diagnosis and treatment decision for those patients. The other challenge is that they're kind of uncommon, so that those types of disease are not being frequently seen.

It's difficult to come up with very large clinical trials for best possible treatment for this patient. However, we have an interest in, and we're doing a lot of patient's advocacy to raise the awareness and to bring people together, working together both from the physician's standpoint but also with patient's interest group and collaborating with research network institutions such as Leukemia Lymphoma Society, Lymphoma Research Society and also a number of other funding agencies.

The focus of this talk today is to try to give an update in terms of how [much]better that we have come along in terms of understanding the biology and the diagnosis classification and treatment options for different subtypes of peripheral T-cell lymphoma.

We hope that we no longer approach peripheral T-cell lymphoma as if it were just a one disease conditioning fact. Each of the subtypes should be better understood and also approached with its specific treatment and ideally incorporating very effective novel agents.

We are in a very active clinical research arena for this particular task. For today's talk, I would focus in on two aspects. One is try to provide update in terms of a genetic evidence from gene expression profiling, mutation analysis, in terms of how we can be better differentiating subtypes peripheral T-cell lymphoma.

What type of genetic pathways, mutations, and what of those could be potentially targeted with novel agents in order to bring a better treatment response for those patients. Secondly, I would review the available novel agents that are either approved or in very active clinical development, both as single agents as well as in combinations for patients with relapsed refractory disease, and how we are making great strives in terms of bringing those combinations into the frontline setting, so that we can apply it to patients who are just recently diagnosed with those diseases and be able to get the best possible combination treatment.

A couple of examples in that direction that we now know that a number of peripheral T-cell lymphoma subtypes express this biomarker CD30. It is uniformly expressed in subtype known as anaplastic large cell T-cell lymphoma. It can also be expressed to a fair percentage in patients with other types of PTCL.

We do have this great novel agent. It's called antibody-drug conjugate brentuximab vedotin. As recently at the end of last year [2018], FDA has approved by incorporating this brentuximab vedotin,, which targets CD30, into the backbone of CHOP but without being crystine so it's brentuximab vedotin plus CHP as a standard of care for patients with newly diagnosed CD30 positive peripheral T-cell lymphoma.

The combination has demonstrated increased response duration and improved progression-free survival and overall survival. That is a great news for patients. It really is a breakthrough therapy for treating peripheral T-cell lymphoma in the front-line setting.

The second example, you know there are a number of epigenetic modifying agents. Some of which are known as HDAC inhibitors. Others are known as hypomethylating agents. We are learning and experimenting of adding those agents on to chemotherapy backbone or in combination with other novel agents and trying to move them to the initial treatment setting.

Specifically, target those PTCL subtypes that have genetic mutation that we think would respond greatly to those combinations. Those approaches are in very active clinical research development.

We are working with our advocacy groups or patient groups for education and study recruitment. We hope to move our front-line novel therapy as quickly as possible and bring what we have learned to our patient care.

In summary, historically, peripheral T-cell lymphoma represents a group of non-Hodgkin lymphoma that are very challenging both from diagnostic and therapeutic aspect. However, encouraging news are coming or just around the corner with our group, the Lymphoma Research Group, collectively for the past decade.

We have learned great deal in terms of understanding how different each subtypes are. What are the potential targets that we can potentially incorporate into a more smart treatment approach, both in the initial treatment as well as relapsed setting.

In doing so, we hope to bring better treatment and improve survival quality of life for our patients with peripheral T-cell lymphoma.